Method and apparatus for orthopedic fixation

ABSTRACT

A dual reconstructive wire system for use with an anatomy can include a first guide wire, a second guide wire, a first guide instrument, a first cannulated insertion instrument, and a second cannulated insertion instrument. The first guide wire can pass through the first cannulated insertion instrument such that a first end and a second end of the first guide wire extends beyond the first end and the second end, respectively of the first cannulated insertion instrument. The second guide wire can pass through the second cannulation insertion instrument such that a first end and a second end of the second guide wire extends beyond the first end and the second end, respectively of the second cannulated insertion instrument.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/519,212 filed on Dec. 17, 2009. This application takes priority fromU.S. Patent Application No. 60/980,302 filed on Oct. 16, 2007, thedisclosure of which is incorporated herein by reference. Thisapplication also takes priority from U.S. Patent Application No.60/980,305 filed on Oct. 16, 2007, which is incorporated herein byreference. Further, this application takes priority from U.S. PatentApplication No. 61/033,443 filed on Mar. 4, 2008, which is incorporatedherein by reference.

INTRODUCTION

In general, the human musculoskeletal system is composed of a variety oftissues including bone, ligaments, cartilage, muscle, and tendons.Tissue damage or deformity stemming from trauma, pathologicaldegeneration, or congenital conditions often necessitates surgicalintervention to restore function. Surgical intervention can include anysurgical procedure that can restore function to the damaged tissue,which can require the use of one or more orthopedic fastening features,such as orthopedic nails, screws, etc., to secure the damaged tissue.

For example, in the case of a hip fracture, a femoral nail and one ormore orthopedic screws can be used to couple a femoral head to a femur.Generally, in order to properly position the one or more orthopedicscrews into an anatomy, a guide and one or more reconstructive guidewires can be used to guide one or more instruments, and/or theassociated orthopedic screw, into the anatomy.

The present teachings provide one or more surgical instruments forrepairing damaged tissue, such as in the case of a hip fracture. Thepresent teachings can also provide one or more orthopedic screws thatcan be inserted in and/or removed from bone using any of a dedicateddriver or any of commonly available drivers. The present teachings canfurther provide a surgical instrument for dual reconstructive wires andassociated method, among other instruments and methods for repairing ahip fracture.

SUMMARY

A dual reconstructive wire system for use with an anatomy can include afirst guide wire, a second guide wire, a first guide instrument, a firstcannulated insertion instrument, and a second cannulated insertioninstrument. The first guide wire can pass through the first cannulatedinsertion instrument such that a first end and a second end of the firstguide wire extends beyond the first end and the second end, respectivelyof the first cannulated insertion instrument. The second guide wire canpass through the second cannulation insertion instrument such that afirst end and a second end of the second guide wire extends beyond thefirst end and the second end, respectively of the second cannulatedinsertion instrument.

The first guide wire can have a first end and a second end. The firstend of the guide wire can be operable to engage the anatomy. The secondend can extend outside the anatomy. The second guide wire can have afirst end and a second end. The first end of the second guide wire canbe operable to engage the anatomy. The second end can extend outside theanatomy. The first guide instrument can have an intramedullary nailengagement feature and a guide that defines a first aperture and asecond aperture. The first cannulated insertion instrument can have afirst end configured to be inserted into the anatomy. The firstcannulated insertion instrument can have a second end configured toextend beyond the anatomy. At least a portion of the first cannulatedinsertion instrument can be received through one of the first apertureor the second aperture. The second cannulated insertion instrument canhave a first end configured to be inserted into the anatomy. The secondcannulated insertion instrument can have a second end configured toextend beyond the anatomy, with at least a portion of the secondcannulated instrument received through the other of the first apertureor the second aperture. The first guide wire can pass through the firstcannulated insertion instrument such that the first end and the secondend of the first guide wire extend beyond the first end and the secondend, respectively, of the first cannulated insertion instrument. Thesecond guide wire can pass through the second cannulated insertioninstrument such that the first end and the second end of the secondguide wire can extend beyond the first end and the second end,respectively, of the second cannulated insertion instrument.

The guide can further comprise a first arm having a proximate endincluding the intramedullary nail engagement feature therein and adistal end. The guide can further include a second arm coupled to thedistal end of the first arm and that defining the first and secondapertures. The guide can further define a third aperture and a fourthaperture. The system can further comprise a fastener that removablycouples the first and second arms. The first guide wire can have acolored coating that visually distinguishes the first guide wire fromthe second guide wire.

According to other features, the system can further comprise at leastone radio-opaque marker disposed in the guide. The first guideinstrument can be substantially L-shaped and configured to engage anantegrade intramedullary nail. According to other features, the firstguide instrument can be substantially U-shaped and configured to engagea retrograde intramedullary nail. The first cannulated insertioninstrument and the second cannulated insertion instrument can eachinclude a trocar and at least two soft tissue sleeves.

According to other features, at least one of the two soft tissue sleevescan have a stop contacting the first guide instrument. The trocar can beoperable to penetrate a soft tissue of the anatomy. A first one of thetwo soft tissue sleeves can be slidable over the trocar and have adiameter that is larger than the trocar to create a passageway throughthe anatomy. A second one of the two soft tissue sleeves can have asecond diameter that is larger than the diameter of the first two softtissue sleeves. The second one of the soft tissue sleeves can beslidable over the first one of the two soft tissue sleeves to create thediameter of the passageway formed by the first soft tissue sleeves inthe anatomy. The passageway formed by the first soft tissue sleevethrough the soft tissue can terminate adjacent to boney tissue in theanatomy.

According to other features, the system can further comprise a gageincluding a first scale and a second scale and that can define a singlebore. The single bore can receive the second end of the first guidewire, which extends beyond the first cannulated insertion instrument tomeasure a depth of the first guide wire within the anatomy with thefirst scale. The gage can receive the second end of the second guidewire, which extends beyond the second cannulated insertion instrument tomeasure a depth of the second guide wire within the anatomy with thesecond scale. According to additional features, the system can furthercomprise a second guide instrument including a post coupling the secondguide instrument to one of the first aperture or the second aperture anddefining a slot for receipt of at least one of the first guide wire andthe second guide wire to verify the alignment of the first guideinstrument with the anatomy. The first cannulated insertion instrumentand the second cannulated insertion instrument can each include a stopmating with the first guide instrument to limit advancement of the firstcannulated instrument and the second cannulated instrument through thefirst aperture and the second aperture, respectively.

A dual reconstructive wire system for use with an anatomy can comprise afirst wire having a first end and a second end. The first end of thefirst guide wire can be operable to engage the anatomy. The second endoperable to extend outside the anatomy. A second guide wire can have afirst end and a second end. The first end of the second guide wire canbe operable to engage the anatomy. The second end can be operable toextend outside the anatomy. The first U-shaped guide instrument can havean intramedullary nail engagement feature on a first end and a guide onan opposite end. The guide can define a first aperture and a secondaperture. The first U-shaped guide instrument can include twoindependent and selectively attachable arms. A first cannulatedinsertion instrument can have a first end that is operable to beinserted into the anatomy with at least a portion of the firstcannulated insertion instrument received through one of the firstaperture or the second aperture. A second cannulated insertioninstrument can have a first end operable to be inserted into the anatomywith at least a portion of the second cannulated instrument receivedthrough the other of the first aperture or the second aperture.

According to other features, the first guide wire can pass through thefirst cannulated insertion instrument such that the first end and thesecond end of the first guide wire extend beyond the first end and thesecond end, respectively, of the first cannulated insertion instrument.The second guide wire can pass through the second cannulated insertioninstrument such that the first end and the second end of the secondguide wire extend beyond the first end and the second end, respectively,of the second cannulated insertion instrument. The two independent armscan comprise a first arm and a second arm. The first arm can have aproximal end including an intramedullary nail engagement feature thereinand a distal end. The second arm can be coupled to the distal end of thefirst arm and define the first and second apertures. The system canfurther comprise a fastener that removably couples the first and secondarms. The first cannulated insertion instrument and the secondcannulated insertion instrument can each include a trocar and at leasttwo soft tissue sleeves.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present teachings.

DRAWINGS

The drawings described herein are for illustration purposes only and arenot intended to limit the scope of the present teachings in any way.

FIG. 1 is a schematic environmental illustration of an exemplaryorthopedic fastener system for repairing an anatomy, such as a hipfracture, according to the present teachings;

FIG. 1A is a schematic environmental illustration of an exemplaryorthopedic fastener system for repairing an anatomy, such as a femoralfracture, according to the present teachings;

FIG. 1B is a detailed illustration of the orthopedic fastening system ofFIG. 1A;

FIG. 2 is a schematic environmental illustration of an exemplary firstguide instrument for guiding one or more orthopedic fasteners into theanatomy according to the present teachings;

FIG. 2A is a schematic environmental illustration of an exemplary imageacquired that includes the first guide of FIG. 2;

FIG. 2B is a schematic detail illustration of the first guide instrumentof FIG. 2;

FIG. 3 is a schematic environmental illustration of a second exemplaryfirst guide instrument for guiding one or more orthopedic fasteners intothe anatomy according to the present teachings;

FIG. 3A is a perspective schematic illustration of a driver noseassociated with the first guide member of FIG. 3;

FIG. 3B is a side view of the first guide instrument of FIG. 3;

FIG. 4 is a top view of a second guide instrument, which can be coupledto the first guide instrument of FIG. 2 for planning a trajectory forthe one or more orthopedic fasteners according to the present teachings;

FIG. 5 is a perspective view of the second guide instrument of FIG. 3;

FIG. 6 is a perspective view of the second guide instrument of FIG. 3;

FIG. 7 is a perspective view of the first guide instrument includingdual reconstructive wires according to the present teachings;

FIG. 8 is a cross-sectional view of the first guide instrument includingthe dual reconstructive wires taken along line 8-8 of FIG. 7;

FIG. 9 is an schematic environmental illustration of the first guideinstrument including the dual reconstructive wires of FIG. 7 shown withthe dual reconstructive wires inserted in an anatomy;

FIG. 10 is a schematic environmental illustration of the first guideinstrument in which a drill bit according to the present teachings isreceived within one of the cannulated insertion instruments;

FIG. 11 is a perspective view of the drill bit of FIG. 10;

FIG. 12 is a cross-sectional view of the drill bit of FIG. 9, takenalong line 12-12 of FIG. 11;

FIG. 13 is a detail perspective view of a proximal end of the drill bitof FIG. 11;

FIG. 14 is a schematic perspective view of an exemplary drill bit stopcoupled to the drill bit of FIG. 11;

FIG. 15 is a perspective view of the drill bit stop of FIG. 14;

FIG. 16 is a cross-sectional view of the exemplary drill bit stop ofFIG. 15, taken along line 16-16 of FIG. 15;

FIG. 17 is a perspective view of a trigger associated with the drill bitstop of FIG. 15;

FIG. 18 is a schematic environmental illustration of the first guideinstrument including a first exemplary orthopedic fastener, such as afirst exemplary orthopedic screw, according to the present teachings;

FIG. 19 is a schematic environmental illustration of an exemplary screwinsertion instrument including a first exemplary orthopedic screwaccording to the present teachings;

FIG. 20 is a partial cross-sectional view of the screw insertioninstrument including the first exemplary orthopedic screw taken alongline 20-20 of FIG. 19;

FIG. 21 is a detail view of the first exemplary orthopedic screw of FIG.19;

FIG. 22 is an schematic environmental illustration showing the insertionof the first exemplary orthopedic screw into the anatomy;

FIG. 23 is a perspective view of a second exemplary orthopedic screwaccording to the present teachings;

FIG. 24 is an enlarged detail of the second exemplary orthopedic screwof FIG. 23;

FIG. 25 is a longitudinal sectional view of the second exemplaryorthopedic screw of FIG. 23;

FIG. 26 is a perspective environmental view showing the second exemplaryorthopedic screw of FIG. 23 with a first driver;

FIG. 27 is a perspective view showing the second exemplary orthopedicscrew of FIG. 23 with a second driver;

FIG. 28 is an enlarged sectional detail of FIG. 27 showing theengagement of the second exemplary orthopedic screw with the seconddriver;

FIG. 29 is a enlarged perspective detail of the second driver of FIG.27;

FIG. 30 is a perspective view showing the second exemplary orthopedicscrew of FIG. 23 with a third driver;

FIG. 31 is an enlarged sectional detail of FIG. 30 showing theengagement of the second exemplary orthopedic fastener with the thirddriver; and

FIG. 32 is an enlarged perspective detail of third driver of FIG. 30.

DESCRIPTION OF VARIOUS ASPECTS

The following description is merely exemplary in nature and is notintended to limit the present teachings, application, or uses. It shouldbe understood that throughout the drawings, corresponding referencenumerals indicate like or corresponding parts and features. Although thefollowing description is related generally to a system and method fororthopedic fixation for use in an anatomy to repair damaged tissue, suchas in a hip fracture, it will be understood that the system and methodorthopedic fixation as described and claimed herein, can be used in anyappropriate surgical procedure. Further, although the orthopedicfasteners illustrated herein are a type of bone screw, the presentteachings can be applied to any type of fastener in which the head ofthe fastener can be constructed to include several interface featuresthat can be used with various drivers. Further, the present orthopedicfixation teachings are applicable to both primary and reconstructionprocedures. Therefore, it will be understood that the followingdiscussions are not intended to limit the scope of the present teachingsand claims herein.

With reference to FIGS. 1 and 1A, an orthopedic fixation system 10 isshown. The orthopedic fixation system 10 can be used to repair damagedtissue in an anatomy, such as a fracture between a femoral head 12 and afemur 14. The orthopedic fixation system 10 can include anintramedullary implant, such as an intramedullary nail 16, one or morereconstructive orthopedic fasteners, such as reconstructive screws 18,and one or more fixation fasteners, such as fixation screws 20.Generally, the intramedullary nail 16 can be inserted into a cavityformed in a medullary canal, and the reconstructive screws 18 can beused to couple the femoral head 12 to the femur via the engagement ofthe reconstructive screws 18 with the intramedullary nail 16. Thefixation screws 20 can secure the intramedullary nail 16 distally to thefemur 14, and can provide additional stability.

As will be discussed, various surgical instruments can be employed tocouple the orthopedic fixation system 10 to the anatomy. For example,with additional reference to FIGS. 2-10, the surgical instruments caninclude a first guide instrument 22 (FIG. 2), a second guide instrument24 (FIGS. 4-6) and a guide wire system 26 (FIGS. 7-9) for use with thefirst guide instrument 22. A drill system 30 (FIG. 10) can be employedwith the guide wire system 26 to prepare the anatomy for receipt of thereconstructive screws 18. Once the anatomy is prepared, thereconstructive screws 18 can be inserted into the anatomy (FIG. 1). Itshould be noted that although the reconstructive screws 18 areillustrated and described herein as being used in combination with theintramedullary nail 16 to perform a trochanteric femoral fixation, itwill be understood that the intramedullary nail 16 as described hereincan be used in various surgical procedure, such as a retrograde femoralfixation procedure, and with various combinations of fasteners, and forexample, could be used with all fixation screws 20 (FIG. 1A), ifdesired.

Intramedullary Nail

With reference to FIG. 1, the intramedullary nail 16 can comprise anysuitable femoral implant, and generally, can comprise a trochanteric orpiriformis fossa entry point antegrade intramedullary nail, or aretrograde intramedullary nail. Suitable trochanteric and piriformisfossa entry point antegrade intramedullary nails and retrogradeintramedullary nails are commercially available from Biomet, Inc. ofWarsaw, Ind. In addition, the intramedullary nail 16 can comprise one ofthe exemplary fixation devices described in U.S. patent application Ser.No. 12/183,142, filed on Jul. 31, 2008, and incorporated by referenceherein. Thus, the intramedullary nail 16 will not be described in greatdetail herein. Briefly, however, with reference to FIGS. 1 and 1A, theintramedullary nail 16 can be composed of a suitable biocompatible metalor metal alloy, and could comprise an antegrade intramedullary nail 16 a(FIG. 1) or a retrograde intramedullary nail 16 b (FIG. 1A).

Antegrade Intramedullary Nail

With reference to FIG. 1, the antegrade intramedullary nail 16 a caninclude a bore 28, which can extend from a proximal end 32 to a distalend 34, and a locking system 36. The bore 28 can facilitate theimplantation of the intramedullary nail 16 into the anatomy, and caninclude internal threads 28 a. The internal threads 28 a can couple thefirst guide instrument 22 to the antegrade intramedullary nail 16 a, aswill be discussed. The proximal end 32 can be angled to facilitate entryof the antegrade intramedullary nail 16 a into the anatomy. The proximalend 32 can include one or more discrete throughbores 38 to enable thereceipt of one or more fasteners, such as the reconstructive screws 18,therethrough. Typically, the proximal end 32 can include a firstthroughbore 38 a, a second throughbore 38 b and a third throughbore 38c, which can be formed at a same starting bore as the first throughbore38 a. Each of the apertures 38 can be formed at an angle to alongitudinal axis of the intramedullary nail 16. The first throughbore38 a and the second throughbore 38 b can have an axis A, and the axis Aof the first throughbore 38 a and the second throughbore 38 b can begenerally parallel to each other and can intersect the longitudinal axisat about an obtuse angle. The third throughbore 38 c can have an axis B,which can intersect each axis A and can intersect the longitudinal axisof the antegrade intramedullary nail 16 a at about an acute angle.

The distal end 34 can include one or more discrete throughbores 40. Forexample, the distal end 34 can include a first throughbore 40 a and asecond throughbore 40 b, each of which can extend substantiallytransverse to the longitudinal axis of the antegrade intramedullary nail16 a. In one example, the first throughbore 40 a can have a circularcross-section, while the second throughbore 40 b can have an ellipticalcross-section. The throughbores 40 can each receive a suitable fastener,such as a fixation screw 20, and the elliptical cross-section of thesecond throughbore 40 b can enable the fixation screw 20 receivedtherethrough to be angled relative to the longitudinal axis of theantegrade intramedullary nail 16 a, if desired.

The locking system 36 of the antegrade intramedullary nail 16 a can bereceived into the bore 28, and generally, can be positioned in the bore28 at the proximal end 32 of the antegrade intramedullary nail 16 a. Thelocking system 36 can comprise any suitable system capable of securingthe reconstructive screws 18 and/or fixation screws 20 to the antegradeintramedullary nail 16 a, such as the CORELOCK™ locking systemcommercially available from Biomet, Inc. of Warsaw, Ind., and describedin commonly-owned in U.S. patent application Ser. No. 12/183,142, filedon Jul. 31, 2008, and incorporated by reference herein. Thus, thelocking system 36 will not be described in great detail herein. Briefly,however, the locking system 36 can be positioned within the proximal end32 such that the reconstructive screws 18 and/or fixation screws 20 canpass through the locking system 36 and the throughbores 38 of theantegrade intramedullary nail 16 a, so that the locking system 36 cansecure the reconstructive screws 18 and/or fixation screws 20 to theantegrade intramedullary nail 16 a.

Retrograde Intramedullary Nail

With reference to FIG. 1A, as the retrograde intramedullary nail 16 bcan have the same or similar features to the antegrade intramedullarynail 16 a, the same or similar reference numerals will be used herein todescribe the same or similar features. The retrograde intramedullarynail 16 b can include a bore 28 b, which can extend from a proximal end32 b to a distal end 34 b, and the locking system 36. The bore 28 b canfacilitate the implantation of the retrograde intramedullary nail 16 binto the anatomy, and can include internal threads 28 c at the distalend 34 b. The internal threads 28 c can couple the first guideinstrument 22 to the retrograde intramedullary nail 16 b, as will bediscussed.

The proximal end 32 b can include one or more discrete throughbores 50to enable the receipt of one or more fasteners, such as the fixationscrews 20, therethrough. Typically, the proximal end 32 b can include afirst throughbore 50 a and a second throughbore 50 b, which can each beformed substantially transverse to a longitudinal axis of the retrogradeintramedullary nail 16 b. In one example, the first throughbore 50 a canhave an elliptical cross-section, while the second throughbore 50 b canhave a circular cross-section. The elliptical cross-section of the firstthroughbore 50 a can enable the fixation screw 20 received therethroughto be angled relative to the longitudinal axis of the retrogradeintramedullary nail 16 b, if desired.

The distal end 34 b can be angled to facilitate entry of the retrogradeintramedullary nail 16 b into the anatomy, if desired. The distal end 34b can include one or more discrete throughbores 52. For example, withreference to FIGS. 1A and 1B, the distal end 34 b can include a firstthroughbore 52 a, a second throughbore 52 b, a third throughbore 52 cand a fourth throughbore 52 d. In one example, the first throughbore 52a and the fourth throughbore 52 d can each extend substantiallytransverse to the longitudinal axis of the retrograde intramedullarynail 16 b, and the second throughbore 52 b and the third throughbore 52c can be substantially oblique to the longitudinal axis.

For example, the first throughbore 52 a can have an axis C, the secondthroughbore 52 b can have an axis D, the third throughbore 52 c can havean axis E, and the fourth throughbore 52 d can have an axis F. In thisexample, the axis C and the axis F can be generally parallel to eachother, while the axis E and the axis D can each be parallel to, butoffset from the axis C and the axis F. For example, the axis E and theaxis D can each be about 10 to about 30 degrees offset from the C axis.

The throughbores 52 can each receive a suitable fastener, such as thefixation screw 20. In one example, the throughbores 52 can each bespaced a distance apart from each other such that the fixation screws 20can be inserted without interference from the adjacent fixation screw20. For example, the first throughbore 52 a can be spaced about 33millimeters (mm) to about 42 mm from an edge 54 of the distal end 34 b,while the second throughbore 52 b can be spaced about 25 mm to about 35mm from the edge 54, the third throughbore 52 c can be spaced about 17mm to about 27 mm from the edge 54 and the fourth throughbore 52 d canbe spaced about 9 mm to about 19 mm from the edge 54.

The locking system 36 of the retrograde intramedullary nail 16 b can bereceived into the bore 28 b, and generally, can be positioned in thebore 28 b at the distal end 34 b of the retrograde intramedullary nail16 b. As the locking system 36 of the retrograde intramedullary nail 16b can comprise any suitable system capable of securing the fixationscrews 20 to the retrograde intramedullary nail 16 b, such as theCORELOCK™ locking system commercially available from Biomet, Inc. ofWarsaw, Ind., and described in commonly-owned in U.S. patent applicationSer. No. 12/183,142, filed on Jul. 31, 2008, and incorporated byreference herein, and discussed herein with reference to the antegradeintramedullary nail 16 a, the locking system 36 for the retrogradeintramedullary nail 16 b will not be described further.

First Guide Instrument

With reference to FIG. 2, the first guide instrument 22 can be coupledthe intramedullary nail 16 to enable a user, such as a surgeon, to guideone or more instruments into the anatomy along a desired path defined bythe first guide instrument 22. As the first guide instrument 22 cancomprise any suitable targeter or guide that can enable a user to directone or more instruments into an anatomy along a desired path, the firstguide instrument 22 will not be described in great detail herein.Briefly, however, the first guide instrument 22 can include anintramedullary nail engagement feature 60 and a guide 62.

Antegrade Intramedullary Nail

In the example of an antegrade procedure involving an antegradeintramedullary nail 16 a, as illustrated in FIG. 2, the intramedullarynail engagement feature 60 can couple the first guide instrument 22 tothe antegrade intramedullary nail 16 a. Generally, the intramedullarynail engagement feature 60 can include any suitable engagement feature,such as a screw, pin, stake, barb, or other equivalent features toenable the first guide instrument 22 to be coupled to the intramedullarynail 16. For example, the intramedullary nail engagement feature 60 caninclude a stem 61 and a bolt 63. The stem 61 can define a bore 64, andcan include one or more projections 66 formed about an end 68, which canengage one or more notches 70 formed in the intramedullary nail 16 toensure the first guide instrument 22 is properly coupled to theintramedullary nail 16. The bore 64 can enable the bolt 63 to passthrough the stem 61. The bolt 63, once inserted into the stem 61, canengage the threads 28 a formed in the antegrade intramedullary nail 16 ato couple the first guide instrument 22 to the antegrade intramedullarynail 16 a.

With continued reference to FIG. 2, the guide 62 can include a first armmember 80 and a second arm member 82. The first arm member 80 caninclude a proximal end 84, a distal end 86 and one or more radio-opaquemarkers 88. In one example, the first arm member 80 can be coupled tothe intramedullary nail engagement feature 60 at the proximal end 84,and can be coupled to the second arm member 82 at the distal end 86.Thus, in the case of an antegrade intramedullary nail 16 a, the guide 62can be substantially L-shaped.

The distal end 86 of the first arm member 80 can include one or moreapertures 90. The apertures 90 can enable the guide wire system 26 to becoupled to, and guided by, the first guide instrument 22. Generally, inthe case of an antegrade intramedullary nail 16 a, for example, thedistal end 86 of the first arm member 80 can include a single aperture90, which can enable the guide wire system 26 to guide a fixation screw20 into the third throughbore 40 c of the antegrade intramedullary nail16 a in an interlock procedure (not specifically shown).

The radio-opaque markers 88 can be disposed within the first arm member80. For example, with reference to FIG. 2A, two radio-opaque markers 88can be disposed within the first arm member 80 and can be generallyparallel to, but spaced apart from each other in the same plane suchthat a lateral image acquired by a suitable imaging source, such as aC-arm fluoroscope, can illustrate the location of the two radio-opaquemarkers 88. Generally, the radio-opaque markers 88 can be positionedsuch that when the first guide instrument 22 is coupled to theintramedullary nail 16, the radio-opaque markers 88 provide guide linesfor the surgeon to ensure that the proximal end 32 of the intramedullarynail 16 is properly located within the anatomy. Thus, as shown in FIG.2A, in a lateral image of an antegrade intramedullary nail 16 a, theradio-opaque markers 88 can define a range or boundary for the positionof the proximal end 32 of the antegrade intramedullary nail 16 a withinthe anatomy.

With reference back to FIG. 2, the second arm member 82 of the guide 62can include a proximal end 96 and a distal end 98. The proximal end 96of the second arm member 62 can be coupled to the distal end 86 of thefirst arm member 80, such as through a fastener 97, and the distal end98 can include one or more apertures 100, as best shown in FIG. 2B. Theapertures 100 can enable the guide wire system 26 to be coupled to, andguided by, the first guide instrument 22. Generally, in the case of anantegrade intramedullary nail 16 a, for example, the distal end 98 ofthe second arm member 82 can include four apertures 100, which canenable the guide wire system 26 to guide multiple reconstructive screws18 into the anatomy. For example, a first aperture 100 a and a secondaperture 100 b can be angled to guide a first and a secondreconstructive screw 18 a into the anatomy during a trochantericprocedure involving an appropriate antegrade intramedullary nail 16 a. Athird aperture 100 c and a fourth aperture 100 d can be angled to guidea first and a second reconstructive screw 18 a into the anatomy during apiriformis fossa procedure involving an appropriate antegradeintramedullary nail 16 a.

Retrograde Intramedullary Nail

With reference to FIG. 3, in the case of a retrograde intramedullarynail 16 b, the guide 22 can include an intramedullary nail engagementfeature 60 b, which can couple the first guide instrument 22 to theretrograde intramedullary nail 16 b. The intramedullary nail engagementfeature 60 b can include any suitable engagement feature, such as ascrew, pin, stake, barb, or other equivalent features to enable thefirst guide instrument 22 to be coupled to the retrograde intramedullarynail 16 b. For example, in the case of a retrograde intramedullary nail16 b, the intramedullary nail engagement feature 60 b can include adriver nose 72 and a bolt 74, as shown in FIG. 3A. The driver nose 72can define a bore 75 (FIG. 3A), a throughbore 77, and can include one ormore projections 76 formed about an end 78, which can engage one or morenotches 79 formed in the intramedullary nail 16 b to ensure the firstguide instrument 22 is properly coupled to the intramedullary nail 16.The bore 75 can enable the bolt 74 to pass through the driver nose 72.The bolt 74, once inserted into the driver nose 72, can engage thethreads 28 c formed in the retrograde intramedullary nail 16 b to couplethe first guide instrument 22 to the retrograde intramedullary nail 16b.

With reference to FIG. 3, the guide 62 b associated with a retrogradeintramedullary nail 16 b can include a first arm member 80 b and asecond arm member 82 b. The first arm member 80 b can include a proximalend 84 b and a distal end 86 b. In one example, the first arm member 80b can be coupled to the intramedullary nail engagement feature 60 at theproximal end 84 b, and can be coupled to or integrally formed with thesecond arm member 82 b at the proximal end 84 b. Thus, in the case of aretrograde intramedullary nail 16 b, the guide 62 can be substantiallyU-shaped and can be formed into one-piece.

With reference to FIG. 3B, the distal end 86 b of the first arm member80 b can include one or more apertures 102. The apertures 102 can enablethe guide wire system 26 to be coupled to, and guided by, the firstguide instrument 22. Generally, in one example, as illustrated in FIG.3B, the distal end 86 b of the first arm member 80 b can include threeapertures 102, a first aperture 102 a, a second aperture 102 b and athird aperture 102 c. The first aperture 102 a can be configured todirect the guide wire system 26 to position a fastener, such as afixation screw 20, in an oblique location in the anatomy. The firstaperture 102 a can be positioned above the second aperture 102 b and thethird aperture 102 c, and can be angled towards the second aperture 102b and the third aperture 102 c to facilitate the placement of thefixation screw 20 at an oblique angle. The second aperture 102 b and thethird aperture 102 c can generally be positioned adjacent to each otherand transverse to the anatomy, to direct the guide wire system 26 toposition a fastener, such as a fixation screw 20, in a locationtransverse to the longitudinal axis of the retrograde intramedullarynail 16 b.

The second arm member 82 b of the guide 62 can include a proximal end 96b and a distal end 98 b. The proximal end 96 b of the second arm member62 can be coupled to the distal end 86 b of the first arm member 80 b,and the distal end 98 b can include the one or more apertures 102associated with the distal end 86 b of the first arm member 80 b. As theapertures 102 of the distal end 98 b of the second arm member 82 b canbe substantially similar to the apertures 102 of the distal end 86 b ofthe first arm member 80 b, the distal end 98 b will not be discussedfurther herein.

Thus, in both an antegrade and a retrograde procedure, the guide 62 ofthe first guide instrument 22 can serve to direct a user, such as asurgeon, in the placement of the reconstructive screws 18 and/orfixation screws 20 relative to the anatomy, via the guide wire system26.

Second Guide Instrument

With reference to FIGS. 4-6, the second guide instrument 24 can beselectively coupled to the first guide instrument 22. Generally, thesecond guide instrument 24 can be used to ensure that the antegradeintramedullary nail 16 a and first guide instrument 22 are properlyaligned during an antegrade procedure. It should be understood, however,that the second guide instrument 24 as described and illustrated hereinmay be applicable to various other surgical procedures, and thus, maynot be limited to an antegrade procedure. Typically, the second guideinstrument 24 can include a body 110 and a post 112.

As best shown in FIGS. 5 and 6, when used with an antegrade procedure,the body 110 can be generally D-shaped, and can define an opening 114, abore 116 substantially opposite the opening 114, one or more grippingmembers 118 and a slot 120. The opening 114 can enable the second guideinstrument 24 to be positioned onto the first guide instrument 22, andthus, the opening 114 can be about equal to a width of the first guideinstrument 22. The opening 114 can be defined by ends 122 of the body110. The post 112 can be coupled to the bore 116 and the post 112 canpass through the bore 116 and into one of the apertures 90 of the firstguide instrument 22 to secure and align the second guide instrument 24with the first guide instrument 22. Generally, the second guideinstrument 24 can be aligned with the aperture 90 associated with thedesired reconstructive procedure, such as a trochanteric or piriformisfossa procedure.

The gripping members 118 can be coupled to or formed on the ends 122 ofthe body 110, and can generally engage the first guide instrument 22when the second guide instrument 24 is coupled to the first guideinstrument 22 to further secure the second guide instrument 24 to thefirst guide instrument 22. In one example, the gripping members 118 canbe projections that extend from the ends 122, but the gripping members118 could also comprise bearings, notches, ball plungers, etc. formed ofany suitable metal, metal alloy or polymeric material suitable to gripthe surface of the first guide instrument 22.

With reference to FIGS. 4-5, the slot 120 can generally be formed on atop surface 124 of the body 110. The slot 120 can have a width sized toreceive one or more guide wires, such as the guide wires 202, 204discussed with regard to the guide wire system 26, which can serve asradio-opaque markers during an image acquired by a suitable imagingdevice, such as a fluoroscopic C-arm. The slot 120 can generally beformed on the top surface 124 so that when the guide wires 202, 204 arereceived into the slot 120, the guide wires 202, 204 can be aligned witha trajectory of the guide wire system 26 through the respective aperture90 on the first guide instrument 22. Thus, when an image is taken of thesecond guide instrument 24, the guide wires 202, 204 can illustrate thetrajectory through the respective aperture 90 associated with the firstguide instrument 22.

In one example, two guide wires 202, 204 can be received into the slot120. Then, an image can be obtained using the imaging device. The imagecan illustrate the positioning of the guide wire system 26 into thefemur 14 and femoral head 12. In addition, if only one guide wire 202,204 appears in the image, then the surgeon can ensure that he hasobtained a substantially true anterior-posterior image.

The post 112 can be received through the bore 116 and into therespective aperture 90 to couple the second guide instrument 24 to thefirst guide instrument 22. The post 112 can have a length sized suchthat the post 112 can terminate substantially adjacent to a side S ofthe first guide instrument 22, as best shown in FIG. 4. Typically, thepost 112 does not serve as a radio-opaque marker for identifying atrajectory through the first guide instrument 22 as the post 112 doesnot extend sufficiently towards the anatomy.

Thus, the second guide instrument 24 in combination with one or moreguide wires 202, 204 can be used to verify the proposed trajectory ofthe guide wire system 26 based on the current alignment of the firstguide instrument 22, which can ensure that any fasteners guided by theguide wire system 26 may be inserted into the desired aperture 38 in theantegrade intramedullary nail 16 a.

Guide Wire System

In one example, with reference to FIGS. 7-9, in the case of an antegradeintramedullary nail 16 a (FIG. 9), the guide wire system 26 can includeone or more cannulated insertion instruments 200, a first reconstructiveguide wire 202, a second reconstructive guide wire 204 and a measuringgage 206. Although the guide wire system 26 is discussed and illustratedherein as being used with an antegrade intramedullary nail 16 a, it willbe understood that the guide wire system 26 can be used with aretrograde intramedullary nail 16 b with substantially little or nomodification, and thus, the discussion and illustration of the guidewire system 26 is not intended to limit the guide wire system 26 to onlyan antegrade surgical procedure.

The cannulated insertion instrument 200 can be received into theapertures 100 to guide the first reconstructive wire 202 and the secondreconstructive wire 204 into the anatomy. As the cannulated insertioninstrument 200 can comprise any instrument suitable for guiding thefirst reconstructive wire 202 and the second reconstructive wire 204into the anatomy until the first reconstructive wire 202 and the secondreconstructive wire 204 are adjacent to a bone in the anatomy, such as afemur, the cannulated insertion instrument 200 will not be discussed ingreat detail herein. Briefly, however, with reference to FIG. 2, thecannulated insertion instrument 200 can include one or more soft tissuesleeves 208 and a trocar (not specifically shown). It should be notedthat although two cannulated insertion instruments 200 are illustratedherein, any number of cannulated insertion instruments 200 could beemployed, and further, the same reference numerals will be used todenote the same or similar features of the illustrated cannulatedinsertion instruments 200. Generally, with reference to FIGS. 7 and 8,the cannulated insertion instrument 200 can include three soft tissuesleeves 208, however, any suitable number of soft tissue sleeves 208could be employed. The soft tissue sleeves 208 can each define athroughbore 210, and a diameter of each of the soft tissue sleeves 208can increase relative to each other soft tissue sleeve 208 such that thesoft tissue sleeves 208 can be nested within each other.

In this regard, the soft tissue sleeves 208 can be assembled one insideof the other and the trocar can be inserted within an innermost softtissue sleeve 208 a. The assembly of the soft tissue sleeves 208 withthe trocar can form a generally conical shape, which can facilitateinsertion of the cannulated insertion instrument 200 into the anatomy.In addition, the outer soft tissue sleeve 208 b can include a stop 208c, which can abut the first guide instrument 22, and for example, canengage a notch 22 a formed at adjacent to the apertures 100 of thesecond arm member 82. The stop 208 c can thereby provide a depth stopfor the insertion of the soft tissue sleeves 208 into the anatomy, andcan also be used by the surgeon in the planning of the respectivesurgical procedure.

Once the soft tissue sleeves 208 are inserted to a desired depth in theanatomy, such as adjacent to a desired bone in the anatomy, the trocarcan be removed and the throughbore 210 of the innermost soft tissuesleeve 208 a can be used to guide one or more instruments to the bone inthe anatomy, such as the first reconstructive wire 202 and the secondreconstructive wire 204. In addition, the known length of the softtissue sleeves 208 can enable the user, such as the surgeon, to measurea depth of the first reconstructive wire 202 and the secondreconstructive wire 204 within the anatomy, as will be discussed.

With reference to FIGS. 7 and 8, the first reconstructive wire 202 canbe configured to guide an instrument and/or an implant into the anatomy,such as a drill and/or an orthopedic screw. The first reconstructivewire 202 can be comprised of any suitable biocompatible material, suchas a metal, metal alloy or polymer, and can include the colored coating202 a, such as a titanium nitride coating, to enable the user tovisually distinguish between the first reconstructive wire 202 and thesecond reconstructive wire 204. The first reconstructive wire 202 caninclude a first end 214 and a second end 216. The first end 214 caninclude a bone engagement feature, such as a plurality of threads, ataper, stake, barbs or other equivalent feature to couple the firstreconstructive wire 202 to the anatomy. With reference to FIG. 8, thesecond end 216 can extend a distance D beyond an end 218 of theoutermost soft tissue sleeve 208 b to enable the user, such as thesurgeon, to guide one or more instruments or implants into the anatomy.

Further, the first reconstructive wire 202 can have a length L that isselected to enable the first reconstructive wire 202 to extend throughthe soft tissue sleeves 208 such that the first end 214 can engage thebone in the anatomy FIG. 8. Generally, with reference to FIG. 8, thelength L of the first reconstructive wire 202 can enable the second end216 of the first reconstructive wire 202 to extend the distance D fromthe end 218 of the outermost soft tissue sleeve 208 b. For example, thelength L of the first reconstructive wire 202 can range from about 400millimeters to about 500 millimeters, and generally, can range fromabout 430 millimeters to about 490 millimeters. As a length of theoutermost soft tissue sleeve 208 b is known, and the length L of thefirst reconstructive wire 202 is known, by measuring the distance D ofthe first reconstructive wire 202 that extends from the end 218 of theoutermost soft tissue sleeve 208 b, the user can determine the depth ofthe first reconstructive wire 202 within the anatomy.

With reference to FIGS. 7-9, the second reconstructive wire 204 can beconfigured to guide an instrument and/or an implant into the anatomy,such as a drill and/or an orthopedic screw. The second reconstructivewire 204 can be comprised of any suitable biocompatible material, suchas a metal, metal alloy or polymer, and can comprise a polished metalfinish, to enable the user to visually distinguish between the secondreconstructive wire 204 and the first reconstructive wire 202. Thesecond reconstructive wire 204 can include a first end 220 and a secondend 222. The first end 220 can include a bone engagement feature, suchas a plurality of threads, a taper, stake, barbs or other equivalentfeature to couple the second reconstructive wire 204 to the anatomy. Thesecond end 222 can extend a distance D2 beyond the end 218 of theoutermost soft tissue sleeve 208 b to enable the user, such as thesurgeon, to guide one or more instruments or implants into the anatomy,such as the reconstructive screws 18.

In addition, the second reconstructive wire 204 can have a length L2that is selected to enable the second reconstructive wire 204 to extendthrough the soft tissue sleeves 208 such that the first end 220 of thesecond reconstructive wire 204 can engage the bone in the anatomy.Generally, the length L2 of the second reconstructive wire 204 canenable the second end 222 of the second reconstructive wire 204 toextend the distance D2 from the end 218 of the outermost soft tissuesleeve 208 b. For example, the length L2 of the second reconstructivewire 204 can range from about 430 millimeters to about 550 millimeters,and generally, can range from about 495 millimeters to about 555millimeters. As the length of the outermost soft tissue sleeve 208 b isknown, and the length L2 of the second reconstructive wire 204 is known,by measuring the distance D2 of the second reconstructive wire 204 thatextends from the end 218 of the outermost soft tissue sleeve 208 b, theuser can determine the depth of the second reconstructive wire 204within the anatomy.

Typically, the second reconstructive wire 204 can have a longer lengthL2 than the length L of the first reconstructive wire 202 such that thesecond reconstructive wire 204 can be inserted into the anatomy afterthe insertion of the first reconstructive wire 202 to preventinstruments associated with the placement of the second reconstructivewire 204 from contacting the first reconstructive wire 202, as will bediscussed below. Generally, the difference between the lengths L and L2of the first reconstructive wire 202 and the second reconstructive wire204 can range from about 30 millimeters to about 150 millimeters, andtypically between about 30 millimeters and about 100 millimeters.

With reference to FIG. 8, the measuring gage 206 can enable the user tomeasure the distance D of the first reconstructive wire 202 and thedistance D2 of the second reconstructive wire 204 that extends beyondthe end 218 of the outermost soft tissue sleeve 208 b. This can enablethe user, such as the surgeon, to determine the depth of the respectivefirst reconstructive wire 202 and the second reconstructive wire 204within the anatomy. The measuring gage 206 can include a bore 230, afirst reconstructive wire calibration scale 232 and a secondreconstructive wire calibration scale 234.

As best illustrated in FIG. 7, the bore 230 can enable the user to slidethe measuring gage 206 onto the second end 216 or second end 222 of therespective first reconstructive wire 202 or the second reconstructivewire 204. The first reconstructive wire calibration scale 232 caninclude one or more calibration markings 232 a and a key 232 b. Thecalibration markings 232 a can enable the user to determine the depth ofthe first reconstructive wire 202 within the anatomy when the measuringgage 206 is inserted over the second end 216 of the first reconstructivewire 202 and adjacent to the end 218 of the outermost soft tissue sleeve208 b. Thus, the calibration markings 232 a can convert the distance Dof the second end 216 into a measurement that corresponds to the depthof the first reconstructive wire 202 within the anatomy. The key 232 bcan comprise at least one color-coded area that can correspond with thecolored coating of the first reconstructive wire 202, such as gold, toenable the user to visually verify that the first reconstructive wire202 is properly aligned within the measuring gage 206. By measuring thedepth of the first reconstructive wire 202 with the measuring gage 206,the user can verify that the first reconstructive wire 202 is properlypositioned within the anatomy.

The second reconstructive wire calibration scale 234 can include one ormore calibration markings 234 a and a key 234 b. The calibrationmarkings 234 a can enable the user to determine the depth of the secondreconstructive wire 204 within the anatomy when the measuring gage 206is inserted over the second end 222 of the second reconstructive wire204 and adjacent to the end 218 of the outermost soft tissue sleeve 208b. Thus, the calibration markings 234 a can convert the distance D2 ofthe second end 222 into a measurement that corresponds to the depth ofthe second reconstructive wire 204 within the anatomy. The key 234 b cancomprise at least one color coded area that can correspond with thecolor of the second reconstructive wire 204, such as gray or silver, toenable the user to visually verify that the second reconstructive wire204 is properly aligned within the measuring gage 206. By measuring thedepth of the second reconstructive wire 204 with the measuring gage 206,the user can verify that the second reconstructive wire 204 is properlypositioned within the anatomy.

With reference to FIG. 9, the guide wire system 26 can be used to guideone or more instruments into an anatomy, such as the femur 14, whichincludes the femoral head 12. In order to couple the guide wire system26 to femur 14 and femoral head 12, the first guide instrument 22 can becoupled to the antegrade intramedullary nail 16 a disposed in the femur14. In this regard, the intramedullary nail engagement feature 60 of thefirst guide instrument 22 can be coupled to the antegrade intramedullarynail 16 a such that the apertures 90 of the guide 62 can be properlyaligned to enable the insertion of the first reconstructive wire 202 andthe second reconstructive wire 204 into a desired position.

With the first guide instrument 22 coupled to the antegradeintramedullary nail 16 a, the soft tissue sleeves 208 can be assembledwithin each other, and the trocar can be inserted into the innermostsoft tissue sleeve 208 a. The assembled soft tissue sleeves 208 andtrocar can then be inserted into the anatomy until the cannulatedinsertion instrument 200 reaches the femur 14 and femoral head 12. Thisprocess can be repeated as necessary to provide passageways for adesired number of reconstructive wires within the anatomy, and thus, theillustration of two cannulated insertion instruments 200 is merelyexemplary, as any number of cannulated insertion instruments 200 couldbe inserted into the anatomy.

Once the cannulated insertion instruments 200 contact the femur 14 andfemoral head 12, the trocar can be removed from the soft tissue sleeves208, and the first reconstructive wire 202 can be inserted into theanatomy. The first reconstructive wire 202 can be driven through thethroughbore 210 of the innermost soft tissue sleeve 208 a. The firstreconstructive wire 202 can be driven into the anatomy via any suitableinstrument, such as through a powered instrument (e.g., a drill) or amanually powered instrument (e.g., manual manipulation of the second end216 of the first reconstructive wire 202). Once the first reconstructivewire 202 is coupled to the anatomy, the second reconstructive wire 204can be coupled to the anatomy.

Due to the length L of the first reconstructive wire 202 (FIG. 8), thesecond reconstructive wire 204 can be coupled to the anatomy withoutcontacting the first reconstructive wire 202. In this regard, theinstrument used to drive the second reconstructive wire 204 cannotcontact the first reconstructive wire 202 as the second end 222 of thesecond reconstructive wire 204 extends at least a distance D3 beyond thesecond end 216 of the first reconstructive wire 202. With reference toFIG. 9, in order to drive the second reconstructive wire 204 into theanatomy, the second reconstructive wire 204 can be driven through thethroughbore 210 of the innermost soft tissue sleeve 208 a. The secondreconstructive wire 204 can be driven into the anatomy via any suitableinstrument, such as through a powered instrument (e.g., a drill) or amanually powered instrument (e.g., manual manipulation of the second end222 of the second reconstructive wire 204).

With the first reconstructive wire 202 and the second reconstructivewire 204 coupled to the anatomy, the measuring gage 206 can be used toverify that the first reconstructive wire 202 and the secondreconstructive wire 204 are at a desired depth in the anatomy. The usercan slide the measuring gage 206 over the second end 216 of the firstreconstructive wire 202 and can use the first reconstructive wirecalibration scale 232 to measure the distance D that the firstreconstructive wire 202 extends beyond the outermost soft tissue sleeve208 b, which can correspond to the depth of the first reconstructivewire 202 within the anatomy, as shown in FIGS. 7-9. Then, the user canslide the measuring gage 206 over the second end 222 of the secondreconstructive wire 204 and can use the second reconstructive wirecalibration scale 234 to measure the distance D2 that the secondreconstructive wire 204 extends beyond the outermost soft tissue sleeve208 b, which can correspond to the depth of the second reconstructivewire 204 within the anatomy. If the first reconstructive wire 202 andthe second reconstructive wire 204 are properly positioned within theanatomy, then the user can use the first reconstructive wire 202 and thesecond reconstructive wire 204 to guide one or more instruments into theanatomy, such as the drill system 30 and/or the reconstructive screws18.

Drill System

With reference to FIG. 10, the drill system 30 can be employed with theguide wire system 26 to prepare the anatomy for receipt of thereconstructive screws 18. It should be understood that although thedrill system 30 is described and illustrated herein as being used in anantegrade procedure involving the antegrade intramedullary nail 16 a,the drill system 30 can be used in any suitable surgical procedure, suchas in a retrograde surgical procedure. Generally, the drill system 30can configured to pass over the first reconstructive wire 202 and thesecond reconstructive wire 204 so that the guide wire system 26 canguide the drill system 30 into the desired position in the anatomy. Thedrill system 30 can generally include a drill bit 300 and a drill stop302. The drill bit 300 can be used to form a bore in the anatomy thathas a depth or length set by the manipulation of the drill stop 302.

With reference to FIGS. 11-13, the drill bit 300 can be formed of anysuitable metal, metal alloy or composite material, and can be cannulatedso that the drill bit 300 can be passed over and directed by the guidewire 202, 204 into the anatomy (FIGS. 10 and 12). The drill bit 300 caninclude a proximal end 304, an intermediate portion 306 and a distal end308. With reference to FIGS. 12 and 13, the proximal end 304 can beconfigured to cut through the anatomy, and can include one or morecutting sections 310 through which one or more cutting flutes 312 passto comprise a cutting surface for the drill bit 300.

The cutting sections 310 can include about four cutting sections, afirst cutting section 310 a, a second cutting section 310 b, a thirdcutting section 310 c and a fourth cutting section 310 d, however, anynumber of cutting sections 310 could be employed, from about one cuttingsection 310 to about ten cutting sections 310, for example. The cuttingsections 310 a-d can be configured to provide a lead-in for the drillbit 300 into the anatomy. In this regard, the cutting sections 310 caneach increase in diameter from the first cutting section 310 a to thefourth cutting section 310 d to facilitate the engagement andadvancement of the drill bit 300 into the anatomy. In one example, anangle from about thirty to about sixty degrees can be provided betweeneach of the cutting sections 310 to transition between the cuttingsections 310. In addition, with reference to FIG. 13, the cuttingsections 310 can generally increase in diameter from about 0.01millimeters (mm) to about 0.03 mm starting from the first cuttingsection 310 a. Thus, the second cutting section 310 b can have adiameter d_(b) about 0.01 mm to about 0.03 mm greater than a diameterd_(a) of the first cutting section 310 a, the third cutting section 310c can have a diameter d_(c) about 0.01 mm to about 0.03 mm greater thanthe diameter d_(b) of the second cutting section 310 b and the fourthcutting section 310 d can have a diameter d_(d) about 0.01 mm to about0.03 mm greater than the diameter d_(c) of the third cutting section 310c.

Generally, as shown in FIG. 12, the drill bit 300 can include about fourcutting flutes 312, however, it will be understood that the drill bit300 can include any desirable number of cutting flutes 312, from abouttwo to about eight, for example. The cutting flutes 312 can wind aboutthe proximal end 304 of the drill bit 300 and can form a continuouscutting surface that transitions in diameter along the cutting sections310, as shown in FIG. 13. In one example, if four cutting flutes 312 areformed on the drill bit 300, each cutting flute 312 can be about evenlyspaced apart from each other, and can each be formed to have an about 20degrees to about 40 degrees right hand spiral.

With reference to FIG. 11, the intermediate portion 306 can couple theproximal end 304 to the distal end 308 and can include one or more depthmarkers 314. The depth markers 314 can be formed about the diameter ofthe intermediate portion 306, and can each be spaced by a groove 314 a.The depth markers 314 can include a depth label 314 b. The depth label314 b can indicate a depth of the drill bit 300 in the anatomy, andthus, the depth markers 314 can cooperate with the drill stop 302 toenable the section of a desired depth for the drill bit 300 to traversewithin the anatomy, as will be discussed further herein. Generally, thedepth markers 314 can indicate the depth in millimeters, however, thedepth markers 314 could correspond to any desired measurement scale.

The distal end 308 can be configured to enable the drill bit 300 to becoupled to a suitable drill. As the drill bit 300 can be coupled to anysuitable drill, via the distal end 308, the distal end 308 will not bedescribed in great detail herein. Briefly, however, note that the distalend 308 can include at least one groove 308 a. The at least one groove308 a can enable a chuck of the drill to engage the drill bit 300, as isgenerally known.

With reference to FIGS. 10 and 14-17, as discussed, the drill stop 302can cooperate with the drill bit 300 to enable the surgeon to select adesired depth for the drill bit 300 to traverse in the anatomy (FIG.14). The drill stop 302 can include a housing 320 and a trigger 322. Itshould be noted that although the housing 320 and trigger 322 areillustrated and described herein as separate, discrete components, thehousing 320 and trigger 322 could be integrally formed, if desired.

With reference to FIGS. 15 and 16, the housing 320 can be generallycylindrical, and can include a proximal end 324, a distal end 326 and athroughbore 328 (FIG. 16), which can extend from the proximal end 324 tothe distal end 326. The proximal end 324 can be configured to contact,but not pass through, the soft tissue sleeves 208 of the guide wiresystem 26 (FIG. 10). Thus, the proximal end 324 can generally have adiameter that is larger than the diameter of the outer soft tissuesleeve 208 b to stop the advancement of the drill bit 300 into theanatomy.

With reference back to FIGS. 15 and 16, the distal end 326 can include atrigger slot 330 and one or more flanges 332. The trigger slot 330 canbe sized to enable the trigger 322 to fit within the housing 320, andthus, in one example, the trigger slot 330 can include a first portion330 a and a second portion 330 b, as shown in FIG. 16. The first portion330 a can generally be wider than the second portion 330 b, and can besized such that the trigger 322 extends beyond a surface of the housing320 when the trigger 322 is in a first, locked position. In a second,unlocked position, the trigger 322 can generally be about planar withthe surface of the housing 320. The second portion 330 b can extendbeyond the throughbore 328 to enable the trigger 322 to engage the drillbit 300, as will be discussed. The second portion 330 b can also includea generally flat portion 330 c. As will be discussed, the trigger 322can be biased against the flat portion 330 c between the first, lockedposition and the second, unlocked position.

The flanges 332 can project from the distal end 326. The flanges 332 caninclude about three flanges 332 a-c, spaced about equally apart,however, any number of flanges 332 could be formed at the distal end326, such as two flanges 332. Typically, as best illustrated in FIG. 10,at least two of the flanges 332 can provide a window through which thesurgeon can view the depth label 314 b of the drill bit 300. This canenable the surgeon to align the housing 320 so that the desired depthfor the drill bit 300 as indicated by the depth marker 314 is viewablebetween two of the flanges 332.

With reference back to FIG. 16, the throughbore 328 of the housing 320can be sized to enable the drill bit 300 to pass through the housing320. Generally, the throughbore 328 can be sized such that at least theproximal end 304 and the intermediate portion 306 of the drill bit 300can pass through the housing 320.

With reference to FIGS. 10, 14 and 17, the trigger 322 can be receivedwithin the trigger slot 330 of the housing 320, and can be operable toenable the surgeon to select the desired depth for the drill bit 300,via the engagement of the trigger 322 with the depth markers 314. Inthis regard, with reference to FIG. 17, the trigger 322 can include abutton 340, a bore 342 and a biasing element 344, which can cooperatewith the housing 320 and the depth markers 314 to limit the advancementof the drill bit 300 to the selected depth. Generally, the button 340,the bore 342 and the biasing element 344 can be integrally formed intoone-piece, however, each of the button 340, the bore 342 and the biasingelement 344 could comprise discrete elements, if desired.

The button 340 can be generally rectangular, and comprise a surface forreceipt of a user-input. The bore 342 can be formed between the button340 and the biasing element 344, and can be sized so that theintermediate portion 306 of the drill bit 300 can pass through thetrigger 322 when the trigger 322 is in the second, unlocked position.The biasing element 344 can comprise any suitable element capable ofproviding a biasing force against the flat portion 330 c of the triggerslot 330, such as a spring. In one example, the biasing element 344 cancomprise a leaf spring, which can include a biasing arm 344 a. Thebiasing arm 344 a can apply the biasing force against the flat portion330 c to enable the trigger 322 to move between the first, lockedposition and the second, unlocked position (FIG. 14).

In this regard, with reference to FIG. 14, with the trigger 322assembled to the housing 320, the biasing arm 344 a biases the trigger322 above the surface of the housing 320. When the trigger 322 extendsbeyond the surface of the housing 320, the bore 342 is not coaxial withthe throughbore 328, and thus, the drill bit 300 cannot pass through thedrill stop 302. Further, at least an edge of the bore 342 can engage thegroove 314 a to secure the drill stop 302 to the drill bit 300. When thetrigger 322 is biased downward, in the second, unlocked position towardthe housing 320, the biasing arm 344 a can move so that the bore 342 ofthe trigger 322 can be coaxially aligned with the throughbore 328. Whenthe bore 342 is coaxially aligned with the housing 320, the drill bit300 can move within the drill stop 302, which can enable the user toselect the desired depth for the drill bit 300 to traverse, by aligningthe desired depth marker 314 between at least two of the flanges 332(FIG. 10).

Thus, the drill system 30 can be employed with the guide wire system 26to enable a user, such as a surgeon, to advance the drill bit 300 to adesired depth within the anatomy, selected via the drill stop 302, inorder to prepare the anatomy for receipt of one or more fasteners, suchas the reconstructive screws 18.

Reconstructive Screws

With reference to FIG. 18, according to various teachings, each of thereconstructive screws 18 can comprise a first exemplary reconstructivescrew 18 a or a second exemplary reconstructive screw 18 b, as will bediscussed. The second exemplary reconstructive screw 18 b can beconfigured to engage various drivers to facilitate the easy removal ofthe second exemplary reconstructive screw 18 b, if desired. Generally,the reconstructive screws 18 can be inserted into an anatomy prepared bythe drill system 30 over the guide wire system 26, however, anyappropriate technique could be used to insert the reconstructive screws18.

First Exemplary Reconstructive Screw

With reference to FIG. 19, in one example, a screw insertion instrument400 can be used to implant each of the orthopedic screws 18 a into theanatomy, as will be discussed below. The screw insertion instrument 400can include a handle 402, an inserter 404, an elongated connectingmember 406 and the reconstructive screw 18 a. Each of the handle 402,inserter 404, elongated connecting member 406 and the reconstructivescrew 18 a can be formed of a sterilizable material, and typically eachcan be formed of a biocompatible material, such as a metal, metal alloy,polymer or combinations thereof.

The handle 402 can enable a user, such as a surgeon, to insert thereconstructive screw 18 a into an anatomy. As the handle 402 cancomprise any suitable graspable or manipulable portion, the handle 402will not be discussed in great detail herein. Briefly, however, thehandle 402 can include a first end 410, a second end 412 and athroughbore 414. The first end 410 can define a recess 410 a that cancouple the elongated connecting member 406 to the handle 402, via apress-fit or a keyed fit, for example. The second end 412 can include aprojection 412 a that is sized to couple the handle 402 to the inserter404, and the projection 412 a can include internal threads, a taper orother equivalent features to enable the inserter 404 to be removablycoupled to the handle 402. The throughbore 414 can pass through therecess 410 a and projection 412 a to enable the elongated connectingmember 406 to pass through the handle 402 and into the inserter 404.

With reference to FIGS. 19 and 20, the inserter 404 can include a firstend 416, a second end 418 and a throughbore 420. The inserter 404 canenable the surgeon to apply a manual torque to the reconstructive screw18 a to drive the reconstructive screw 18 a into an anatomy. The firstend 416 of the inserter 404 can be coupled to the second end 412 of thehandle 402, and can include mating threads, a mating taper, or otherequivalent features to couple the handle 402 to the inserter 404.Alternatively, a surgeon can couple a powered tool, such as a drill, tothe insert 404 to drive the screws 18 into the anatomy. The second end418 can be coupled to the reconstructive screw 18 a. In one aspect, forexample, and with reference to FIG. 20, the second end 418 can include aformed interior surface 422 formed about a portion of the throughbore420 that can be configured to mate with the reconstructive screw 18 a.In one aspect, the interior surface 422 can include a formed hexagonalsurface 422 a that is sized to mate with a head 424 of thereconstructive screw 18 a, as will be discussed below, to couple thereconstructive screw 18 a to the inserter 404. It should be understood,however, that the interior surface 422 can have any desired shape tomate with the head 424, such as notched, keyed, grooved, annular,polygonal, etc. The throughbore 420 can be formed from the first end 416to the second end 418. The throughbore 420 can be sized to enable theelongated connecting member 406 to move relative to the inserter 404. Inthis regard, the throughbore 420 can be sized to enable the elongatedconnecting member 406 to slide and rotate relative to the inserter 404,as will be discussed herein.

With reference to FIGS. 19 and 20, the elongated connecting member 406can be slideably received within the inserter 404 in the case that theinserter 404 is employed with the handle 402 in a manual method. Theelongated connecting member 406 can couple the reconstructive screw 18 ato the handle 402 so that the manual torque generated by the rotation ofthe handle 402 and transferred to the inserter 404 can drive thereconstructive screw 18 a into an anatomy. The elongated connectingmember 406 can include a first end 426, a second end 428 and athroughbore 430. The first end 426 can include a graspable portion 432.The graspable portion 432 can be coupled to the first end 426 via anysuitable technique, such as a press fit, mechanical fasteners, or otherequivalent features, or could be integrally formed with the first end426. The graspable portion 432 can enable the surgeon to insert theelongated connecting member 406 through the handle 402 and inserter 404,and can couple the elongated connecting member 406 to the handle 402 asshown in FIG. 22. The graspable portion 432 can also include a bore 432a that can be aligned with the throughbore 430 of the elongatedconnecting member 406 to enable the elongated connecting member 406 topass over a guide wire (not specifically shown), for example.

With reference to FIG. 20, the second end 428 can be configured tocouple the reconstructive screw 18 a to the elongated connecting member406. In this regard, the second end 428 can include a plurality ofthreads, a keyed projection, a notch, etc. configured to mate with aninternal surface 434 of the head 424 of the reconstructive screw 18 a,as will be discussed. In the example of FIG. 20, the second end 428includes a plurality of threads 428 a formed on an exterior surface 435of the elongated connecting member 406. The throughbore 430 can enablethe elongated connecting member 406 to be positioned over a guide wire(not specifically shown), for example, which can ensure the properpositioning of the reconstructive screw 18 a with respect to an anatomy.

The reconstructive screw 18 a can be used to repair one or more portionsof an anatomy, and for example, as illustrated in FIG. 22, thereconstructive screw 18 a can be used to repair a fracture in thefemoral head 12. The reconstructive screw 18 a can be coupled to theelongated connecting member 406, and can be driven by the inserter 404by torque applied to the handle 402 into an anatomy, such as the femoralhead 12. The reconstructive screw 18 a can be composed of abiocompatible material, such as a metal, metal alloy or polymer, and ifdesired, can comprise a coating, such as an antibiotic coating, acoating to enhance bone ingrowth, etc. With reference to FIGS. 20 and21, the reconstructive screw 18 a can include a first end or the head424, a second end or a fastening portion 440 and a throughbore 442.

The head 424 can be sized to enable the reconstructive screw 18 a toreceive torque from the inserter 404, while enabling the reconstructivescrew 18 a to be coupled to the elongated connecting member 406. Thehead 424 can include a first or exterior surface 444 and a second or theinternal surface 434. The exterior surface 444 can be configured to matewith the second end 418 of the inserter 404. In this example, theexterior surface 444 can comprise a hexagonal surface 444 a, however, itwill be understood that the exterior surface 444 can have any desiredshape to enable the inserter 404 to apply a torque to the reconstructivescrew 18 a, such as annular, ridged, ribbed, polygonal, grooved,notched, dimpled, slotted, keyed, or other equivalent features.

The internal surface 434 can be configured to mate with the second end428 of the elongated connecting member 406 to releasably couple thereconstructive screw 18 a to the elongated connecting member 406. Thus,the internal surface 434 can have any desired shape, such as grooved,notched, slotted, dimpled, keyed, polygonal, etc. For example, theinternal surface 434 can include a plurality of threads 434 a that canmate with the threads 428 a on the second end 428 of the elongatedconnecting member 406 (FIG. 20). By configuring the internal surface 434to mate with the elongated connecting member 406, a diameter D of theelongated connecting member 406 can be reduced, as the diameter of theelongated connecting member 406 can be sized to mate with a diameter D2of the internal surface 434, instead of a diameter D3 of the exteriorsurface 444, for example. By reducing the diameter D of the elongatedconnecting member 406, a diameter D4 of the inserter 404 can also bereduced. In addition, by using the internal surface 434 of the head 424to couple the reconstructive screw 18 a to the elongated connectingmember 406, a diameter D5 of the reconstructive screw 18 a can bereduced. Thus, the use of the internal surface 434 of the head 424 tocouple the reconstructive screw 18 a to the elongated connecting member406 can serve to reduce the size of the screw insertion instrument 400.

The fastening portion 440 of the reconstructive screw 18 a can define atleast one fastening feature that can couple the reconstructive screw 18a to an anatomy. For example, the fastening portion 440 can comprise oneor more threads 440 a, as illustrated, however, it should be noted thatthe fastening portion 440 can comprise any suitable fastening feature,such as a taper, barbs, etc. If the fastening portion 440 comprises thethreads 440 a, then the threads 440 a can be self-tapping andself-drilling to enable the reconstructive screw 18 a to be coupled toan anatomy without necessarily requiring the formation of a pre-tappedbore in an anatomy. The throughbore 442 can be sized to enable thereconstructive screw 18 a to slideably engage a guide wire (notspecifically shown), or to enable other instruments (not shown) to beinserted into an anatomy via the screw insertion instrument 400.

With reference to FIG. 22, the screw insertion instrument 400 can beused to drive the reconstructive screw 18 a into an anatomy, such as thefemoral head 12. In order to drive the reconstructive screw 18 a intothe anatomy, the first end 416 of the inserter 404 can be coupled to thesecond end 412 of the handle 402. Then, the elongated connecting member406 can be inserted through the throughbore 414 of the handle 402 andthe throughbore 420 of the inserter 404. The reconstructive screw 18 acan be coupled to the second end 418 of the inserter 404 such that theinterior surface 422 of the inserter 404 can be coupled to the exteriorsurface 444 of the head 424. With the reconstructive screw 18 a coupledto the inserter 404, the graspable portion 432 of the elongatedconnecting member 406 can be manipulated to couple the internal surface434 of the head 424 of the reconstructive screw 18 a to the second end428 of the elongated connecting member 406. For example, if the internalsurface 434 comprises the plurality of threads 434 a, then the elongatedconnecting member 406 can be rotated by the user, such as the surgeon,to couple the plurality of threads 428 a of the elongated connectingmember 406 to the plurality of threads 434 a of the reconstructive screw18 a.

With the reconstructive screw 18 a coupled to the elongated connectingmember 406 and the inserter 404, the surgeon can place the screwinsertion instrument 400 about a selected guide wire 202, 204 and canguide the reconstructive screw 18 a into a desired position in ananatomy such as the femoral head 12. Once positioned, the surgeon canrotate the handle 402 to drive the reconstructive screw 18 a into ananatomy, such as the femoral head 12. When the reconstructive screw 18 ais secured in the femoral head 12, the surgeon can then manipulate theelongated connecting member 406, via the graspable portion 432, torelease the elongated connecting member 406 from the reconstructivescrew 18 a. The screw insertion instrument 400 can then be removed fromthe anatomy.

Second Exemplary Reconstructive Screw

Referring to FIGS. 23-25, a second exemplary reconstructive screw 18 baccording to the present teachings can include a head 502, an unthreadedshank portion 506, and an externally threaded anchoring portion 504 forengaging bone or other tissue. The head 502 can include a cylindricalbase 510 and a male or outer hex wall 512 extended from the cylindricalbase 510 away from the shank portion 506. The reconstructive screw 18 bcan be cannulated to define an axial internal through bore of stepwisevariable diameters, including a shank bore 524 and first and second headbores 514, 526, as shown in FIG. 25.

Referring to FIGS. 23-25, the head 502 can include a female or innerhexagonal socket surface or inner hex surface 516, on which a femaleright handed thread 518 and a female left handed thread 520 are defined.As a practical matter, each of the right handed and left handed threads518, 520 can be formed on the inner surface of the first inner head bore514, which is cylindrical before the inner hex surface 516 is cut. Theinner hex surface 516 can be formed after the right handed and lefthanded threads 518, 520 are defined, thereby partially interrupting thethreads 518, 520, such that the right handed thread 518 and a lefthanded thread 520, which are deeper than the inner hex surface 516, arestill defined on the sides of the inner hex surface 516. Although thethread area is reduced, sufficient thread area is maintained, such thatboth the right handed and left handed threads 518, 520 remainfunctional.

Accordingly, the head 502 of the reconstructive screw 18 b provides thefollowing concurrent and overlapping driver interface features, whichcan be used selectively for interfacing with an appropriate driver forinserting and/or removing the reconstructive screw 18 b from bone orother tissue:

A. an outer (male) hex surface 512 defined on the outer surface of thehead 502;

B. an inner (female) right handed thread 518 defined on the first innerhead bore 514;

C. an inner (female) left handed thread 520 defined on the first innerhead bore 514; and

D. an inner (female) hex surface 516 defined on the first inner headbore 514.

The above driver interface features allow the use of commonly availablehex drivers, or socket drivers, or threaded engagement drivers. Otherspecialized or dedicated drivers can also be used, as discussed below.

Referring to FIG. 26, a first driver 600 can be used to insert and/orremove the reconstructive screw 18 b in or out of the anatomy, such as afemoral head 12. The first driver 600 can generally include a handle 602and a cannulated inserter shaft 606 passing through the handle 602 andhaving an inner longitudinal bore 610 and a distal inner (female) hexsocket or surface 612. The first driver 600 can also include aconnecting member 608 received through the bore 610 and having an outer(male) threaded distal end 614 and a proximal end coupled to a knob orother holding member 604. The holding member 604 can be accessibleoutside the handle 602 for rotating the connecting member 608. The innerhex surface 612 can be engaged with the outer hex surface 512 of thehead 502 of the reconstructive screw 18 b, and rotated clockwise orcounterclockwise to insert or remove the reconstructive screw 18 b intoor out of the femoral head 12. The threaded distal end 614 of theconnecting member 608 can be threadably engaged to the right handedthread 518 of the inner head bore 514 by turning the holding member 604.The threaded engagement of the connecting member 608 and thereconstructive screw 18 b can stabilize the reconstructive screw 18 bwhile inserting or removing the reconstructive screw 18 b from thefemoral head 12.

Referring to FIGS. 27-29, a second driver 700 can be used to insetand/or remove the reconstructive screw 18 b. The second driver 700 caninclude a cannulated shaft 706 having an inner longitudinal bore 704 anda distal end defining an outer (male) hex surface 702. The outer hexsurface 702 of the second driver 700 can engage the inner hex surface516 of the head 502 of the reconstructive screw 18 b. Rotating thesecond driver 700 clockwise or counterclockwise can insert or remove thereconstructive screw 18 b.

Referring to FIGS. 30-32, a third driver 800 can be used to remove thereconstructive screw 18 b. The third driver 800 can include a cannulatedshaft 806 having an inner longitudinal bore 804 and a distal enddefining a male left handed thread 802. The male left handed thread 802can engage the female left handed thread 520 of the first inner headbore 514 of the reconstructive screw 18 b. After the male left handedthread 802 is fully engaged to the female left handed thread 520 and thethird driver 800 has reached the step surface between the first andsecond head bores 514, 526, the third driver 800 can be rotatedcounterclockwise to remove the reconstructive screw 18 b from thefemoral head 12, while the third driver 800 remains fully engaged to thereconstructive screw 18 b by the engagement of the respective lefthanded threads 802 and 520.

Additionally, an ordinary driver similar to the third driver 800 butwith a right handed thread can be used to insert the reconstructivescrew 18 b, if no other appropriate driver is available.

It will be appreciated that the reconstructive screw 18 b incorporatesseveral driver interface features associated with the head 502 of thereconstructive screw 18 b. Depending on the available drivers, one ormore of these features can be selectively engaged with the availabledriver to insert or remove the reconstructive screw 18 b, as describedabove. Accordingly, when the primary insertion or removal tool that isassociated with the reconstructive screw 18 b is not available duringthe procedure, alternative and more commonly available drivers, such ashex drivers can be used.

While specific examples have been described in the specification andillustrated in the drawings, it will be understood by those of ordinaryskill in the art that various changes can be made and equivalents can besubstituted for elements thereof without departing from the scope of thepresent teachings. Furthermore, the mixing and matching of features,elements and/or functions between various examples is expresslycontemplated herein so that one of ordinary skill in the art wouldappreciate from the present teachings that features, elements and/orfunctions of one example can be incorporated into another example asappropriate, unless described otherwise, above. Moreover, manymodifications can be made to adapt a particular situation or material tothe present teachings without departing from the essential scopethereof. Therefore, it is intended that the present teachings not belimited to the particular examples illustrated by the drawings anddescribed in the specification, but that the scope of the presentteachings will include any embodiments falling within the foregoingdescription.

What is claimed is:
 1. A dual reconstructive wire system for use with ananatomy comprising: a first guide wire having a first end and a secondend, the first end of the first guide wire operable to engage theanatomy, and the second end extending outside the anatomy; a secondguide wire having a first end and a second end, the first end of thesecond guide wire operable to engage the anatomy, and the second endextending outside the anatomy; a first guide instrument having anintramedullary nail engagement feature and a guide that defines a firstaperture and a second aperture; a first cannulated insertion instrumenthaving a first end configured to be inserted into the anatomy, and asecond end configured to extend beyond the anatomy, with at least aportion of the first cannulated insertion instrument received throughone of the first aperture or the second aperture; a second cannulatedinsertion instrument having a first end configured to be inserted intothe anatomy, and a second end configured to extend beyond the anatomy,with at least a portion of the second cannulated instrument receivedthrough the other of the first aperture or the second aperture; andwherein the first guide wire passes through the first cannulatedinsertion instrument such that the first end and the second end of thefirst guide wire extend beyond the first end and the second end,respectively, of the first cannulated insertion instrument, and thesecond guide wire passes through the second cannulated insertioninstrument such that the first end and the second end of the secondguide wire extend beyond the first end and the second end, respectively,of the second cannulated insertion instrument.
 2. The system of claim 1,wherein the guide comprises: a first arm having a proximal end includingthe intramedullary nail engagement feature therein and a distal end; anda second arm coupled to the distal end of the first arm and defining thefirst and second apertures.
 3. The system of claim 2, wherein the guidefurther defines a third aperture and a fourth aperture.
 4. The system ofclaim 2, further comprising a fastener that removably couples the firstand second arms.
 5. The system of claim 1, wherein the first guide wirehas a colored coating to visually distinguish the first guide wire fromthe second guide wire.
 6. The system of claim 1, further comprising atleast one radio-opaque marker disposed in the guide.
 7. The system ofclaim 1, wherein the first guide instrument is substantially L-shapedand is configured to engage an antegrade intramedullary nail.
 8. Thesystem of claim 1, wherein the first guide instrument is substantiallyU-shaped and is configured to engage a retrograde intramedullary nail.9. The system of claim 1, wherein the first cannulated insertioninstrument and the second cannulated insertion instrument each include atrocar and at least two soft tissue sleeves.
 10. The system of claim 9,wherein at least one of the at least two soft tissue sleeves has a stopcontacting the first guide instrument, the trocar operable to penetratea soft tissue of the anatomy, with a first one of the at least two softtissue sleeves slideable over the trocar and having a diameter largerthan the trocar to create a passageway through the anatomy, and a secondone of the at least two soft tissue sleeves having a second diameterlarger than the diameter of the first one of the at least two softtissue sleeves, the second one of the at least two soft tissue sleevesslideable over the first one of the at least two soft tissue sleeves toincrease the diameter of the passageway formed by the first one of theat least two soft tissue sleeves in the anatomy.
 11. The system of claim10, wherein the passageway formed by the first one of the at least twosoft tissue sleeves through the soft tissue terminates adjacent to boneytissue in the anatomy.
 12. The system of claim 1, further comprising: agage including a first scale and a second scale, the gage defining asingle bore, receiving the second end of the first guide wire, whichextends beyond the first cannulated insertion instrument to measure adepth of the first guide wire within the anatomy with the first scale,and receives the second end of the second guide wire, which extendsbeyond the second cannulated insertion instrument to measure a depth ofthe second guide wire within the anatomy with the second scale.
 13. Thesystem of claim 1, further comprising: a second guide instrumentincluding a post coupling the second guide instrument to one of thefirst aperture or the second aperture and defining a slot for receipt ofat least one of the first guide wire and the second guide wire to verifythe alignment of the first guide instrument with the anatomy.
 14. Thesystem of claim 9, wherein the first cannulated insertion instrument andthe second cannulated insertion instrument each include a stop matingwith the first guide instrument to limit advancement of the firstcannulated instrument and second cannulated instrument through the firstaperture and second aperture, respectively.
 15. A dual reconstructivewire system for use with an anatomy comprising: a first guide wirehaving a first end and a second end, the first end of the first guidewire operable to engage the anatomy, the second end operable to extendoutside the anatomy; a second guide wire having a first end and a secondend, the first end of the second guide wire operable to engage theanatomy, the second end operable to extend outside the anatomy; a firstU-shaped guide instrument having an intramedullary nail engagementfeature on a first end and a guide on an opposite end, the guidedefining a first aperture and a second aperture, the first U-shapedguide instrument including two independent and selectively attachablearms; a first cannulated insertion instrument having a first endoperable to be inserted into the anatomy with at least a portion of thefirst cannulated instrument received through one of the first apertureor the second aperture; and a second cannulated insertion instrumenthaving a first end operable to be inserted into the anatomy with atleast a portion of the second cannulated instrument received through theother of the first aperture or the second aperture.
 16. The system ofclaim 15, wherein the first guide wire passes through the firstcannulated insertion instrument such that the first end and the secondend of the first guide wire extend beyond the first end and the secondend, respectively, of the first cannulated insertion instrument, and thesecond guide wire passes through the second cannulated insertioninstrument such that the first end and the second end of the secondguide wire extend beyond the first end and the second end, respectively,of the second cannulated insertion instrument.
 17. The system of claim15, wherein the two independent arms comprise: a first arm having aproximal end including the intramedullary nail engagement featuretherein and a distal end; and a second arm that is coupled to the distalend of the first arm and defines the first and second apertures.
 18. Thesystem of claim 17, further comprising a fastener removably coupling thefirst and second arms.
 19. The system of claim 15, wherein the firstcannulated insertion instrument and the second cannulated insertioninstrument each include a trocar and at least two soft tissue sleeves.20. The system of claim 19, wherein at least one of the at least twosoft tissue sleeves has a stop that contacts the first guide instrument,the trocar operable to penetrate a soft tissue of the anatomy, with afirst one of the at least two soft tissue sleeves slideable over thetrocar and having a diameter larger than the trocar to create apassageway through the anatomy, and a second one of the at least twosoft tissue sleeves having a second diameter larger than the diameter ofthe first one of the at least two soft tissue sleeves, the second one ofthe at least two soft tissue sleeves slideable over the first one of theat least two soft tissue sleeves to increase the diameter of thepassageway formed by the first one of the at least two soft tissuesleeves in the anatomy.